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Results for: Claims and Insurance - Independent Medical Examiner
Title/Description:

Type:

Approved Independent Medical Examiner (IME) Update

This document is used to update or correct an IME's contact, availability, qualifications and/or exam sites information.



Form
F245-051-000


 
Comentarios Sobre el Exámen Médico Independente

Usado por el trabajador lesionado para proporcionarle comentarios a L&I sobre su examen médico reciente de un Examen Médico Independiente (IME, por su sigla en inglés).



Form
F245-053-999



Alt Language(s):
Inglés
 
Independent Medical Exam Doctor's Estimate of Physical Capacities

IME Doctor’s Estimate of Physical Capacities: For use by independent examiners when asked to estimate physical capacities as part of an IME requested by the department.



Form
F242-387-000


 
Independent Medical Exam Template

Template used by a doctor during an independent medical exam.



Form
F245-058-000


 
Independent Medical Examination (IME) Provider Exam Sites

List the locations where the doctor does independent medical exams on a regular basis.



Form
F245-047-000


 
Independent Medical Examination Fax Cover Sheet

Independent Medical Examination Fax Cover Sheet



Form
F245-383-000


 
Medical Examiners' Handbook

Book: A publication for independent medical examiners, attending doctors and consultants, this document contains guidelines, sample reports and billing procedures for preparing and conducting impairment ratings and independent medical exams in Washington's workers' compensation system. Beginning July 1, 2012, free Category I CME credits are available for completing the self-assessment associated with this handbook. Go to www.Imes.Lni.wa.gov and click on Medical Examiners Handbook for information on the exam. L&I and the authors have no financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this document. Find a medical examiner.



Publication
F252-001-000


 
Notice of Independent Medical Exam No-Show or Late Cancellation

Notice of Independent Medical Exam No-Show or Late Cancellation



Form
F245-382-000


 
Provider Account Application - Independent Medical Examiner (IME)

In order to do independent medical exams a provider must obtain a provider account number with L&I. This packet includes the application and agreement with instructions, IME Provider Exam sites form (F245-047-000) and Request for Taxpayer ID and Certification - Form W-9 (F248-036-000) (10 pages). If you have questions, please email balk235@lni.wa.gov or call 360-902-6815.



Form
F245-046-000


 
Su examen médico independiente: para empleadores de negocios autoasegurados

Folleto: Contesta las preguntas más comunes sobre cuándo y por qué puede requerirse que un trabajador lesionado asista a un examen médico independiente.  Incluye el Formulario examen médico Independiente (IME, por su sigla en inglés) Solicitud para el reembolso de gastos de viaje y salario.  Esta publicación es para uso solamente de las empresas autoaseguradas y sus trabajadores.



Publication
F207-202-999



Alt Language(s):
Inglés
 
Su examen médico independiente

Folleto: Respuestas a las preguntas más comunes sobre los exámenes médicos independientes y cuándo y por qué podría requerirse que un trabajador lesionado asistiera a uno.  Incluye el formulario examen médico independiente (IME, por su sigla en inglés) - Solicitud para el reembolso de gastos de viaje y salario. Este formulario es solamente para el uso de negocios autoasegurados y sus trabajadores.



Form
F245-224-999



Alt Language(s):
Inglés
 
Su examen médico independiente

Folleto: Respuestas a las preguntas más comunes sobre los exámenes médicos independientes y cuándo y por qué podría requerirse que un trabajador lesionado asistiera a uno.  Incluye el formulario examen médico independiente (IME, por su sigla en inglés) - Solicitud para el reembolso de gastos de viaje y salario. Este formulario es solamente para el uso de negocios autoasegurados y sus trabajadores.



Publication
F245-224-999



Alt Language(s):
Inglés
 
Your Independent Medical Exam

Pamphlet/booklet: Answers the most common questions about independent medical exams and when and why an injured worker may be required to receive one. Includes the "IME Travel & Wage Reimbursement Request" form.



Form
F245-224-000



Alt Language(s):
Español
 
Your Independent Medical Exam

Pamphlet/booklet: Answers the most common questions about independent medical exams and when and why an injured worker may be required to receive one. Includes the "IME Travel & Wage Reimbursement Request" form.



Publication
F245-224-000



Alt Language(s):
Español
 
Independent Medical Exam Comments
Used by the injured worker to provide comments to L&I about their recent medical exam by an IME.

Form
F245-053-000



Alt Language(s):
Español
 
Your Independent Medical Exam (IME): Crime Victims Compensation Program
Fact Sheet: Provides answers to commonly asked questions about independent medical exams (IMEs) and contact information. Includes a form for requesting travel-related reimbursement for attending an IME.

Publication
F800-115-000


 
Your Independent Medical Exam: For Employees of Self-Insured Businesses
Pamphlet: Answers the most common questions about when and why an injured worker may be required to attend an independent medical exam. Includes the "IME Travel & Wage Reimbursement Request" form. This publication is for use only by self-insured businesses and their workers.

Publication
F207-202-000



Alt Language(s):
Español
 





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